Mrs D gave birth to her fourth child, but first daughter, on 03 November 2010. She was discharged on 05 November 2010. She was seen by a Community Midwife at home on 06 November and by a second Community Midwife on 08 November. Mrs D's husband and family friends were all concerned that she was deteriorating over this period. Their evidence, in the inquest into Mrs D's death, which concluded on 17 July 2013, was that she was suffering from significant abdominal pain, a fever and felt generally weak. The evidence of the Midwife that saw Mrs D on 08 November was completely different. She believed that Mrs D was healthy and reported no concerns.
Mrs D's husband, concerned that his wife was badly deteriorating, took her back to Northwick Park Hospital on 09 November 2010. Mrs D was treated with antibiotics but despite appropriate care, passed away in the very early hours of 10 November 2010.
At the inquest into Mrs D's death, HM Coroner for Greater London (Northern District), Andrew Walker, preferred the evidence given by Mrs D's friends and husband over that of the midwife that had treated Mrs D on 08 November. In particular he was critical of the midwife for assuming that the abdominal pain being complained of by Mrs D was merely afterpains, which were to be expected after giving birth. He felt the midwife took no account of how frequently these pains were present despite the midwife being told that the baby would breast feed for 45 minutes every 3 hours and that the pain was present during this time.
Although questions were asked by the Midwife they did not reveal the true nature of Mrs D's illness. It was the coroner's view that had there been an accurate history taken it would have been clear that Mrs D was seriously unwell and would need to be taken back to the labour ward urgently. Expert evidence was heard which confirmed that had Mrs D been taken to hospital after the visit from the midwife and given appropriate antibiotics she would not have died, provided that antibiotics were given up to 9am on the 9th November 2010.
The coroner ruled that Mrs D's death was contributed to by neglect.
Following the inquest, proceedings were issued against North West London Hospitals NHS Trust, the NHS Trust with responsibility for Northwick Park Hospital. Proceedings were served on 21 August 2013. Notwithstanding the coroner's verdict, the Trust denied that they were responsible for Mrs D's death. In spite of its denial, a substantial offer of settlement was made to Mr D, which he accepted, and which was subsequently approved at the High Court.
At the end of the case Mr D commented:
"When my wife died, I did not know what to do, I knew something went wrong.
After a few days, a lady called me from the coroner office. She gave me Mark Bowman's phone number. I phoned and spoke to him, he was happy to help me, I met him and explained to him what happened. He accepted the case. From that day he was doing a very hard job, he was collecting all the paper work he needed from the hospital and hired experts who helped to identify the errors that had led to my wife's death. Mark was always patient and willing to explain every detail. I trusted him and he led the case to a successful end. With the help of Mark, me and my 4 children are back to the life style which we were living when my wife was alive.
Many thanks to you Mark and well done."
Mark Bowman, partner at Field Fisher Waterhouse, who had conduct of this case, commented:
"This was a particularly sad case. At a time when my client was hoping to celebrate the birth of his first baby girl into the family, he instead had to deal with the trauma of losing his wife. Sepsis is a known risk factor in the post birth period and the Centre for Maternal and Child Enquiries (CMACE) issued a report in 2011 entitled 'Saving Mothers' Lives'. More needs to be done to ensure that symptoms of sepsis in the post-natal period are identified and acted on without delay, to avoid the catastrophic consequences witnessed in this case"
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